Childhood obesity prevention in Massachusetts can serve as nationwide model

15% less weight gain among school kids

A program launched in Somerville, Mass., that aims to reduce childhood obesity and promote healthy lifestyles is being touted as a model for other cities and towns across the nation, USA Today reports. The Somerville initiative began in 2002 as part of efforts conducted by Tufts University researchers seeking to determine whether promoting exercise and healthy eating habits could reduce childhood obesity. Using funding from the federal Centers for Disease Control and Prevention and several philanthropic groups, Somerville schools replaced unhealthy cafeteria items, such as french fries, candy and soda, with nutritious foods including fresh fruits and skim milk. The city also added bike lanes and pedestrian crosswalks to encourage physical activity, residents planted community gardens to grow fresh produce and local restaurants began offering healthier menu items. After one year, children in Somerville gained 15 percent less weight than their peers residing in towns not participating in the initiative, and ridership on the community's bike paths increased twofold. As a result of the improvements, various iterations of the program are now being launched in several other U.S. cities to improve wellness and reduce the burden of chronic disease among both children and adults (Hall, USA Today, 4/21/09 Note: The Robert Wood Johnson Foundation (RWJF) is supporting the expansion of the Shape Up Somerville program through Healthy Kids, Healthy Communities, an RWJF national program.)

Promising Results Shown In Childhood Obesity Intervention

Shape Up Somerville: Eat Smart. Play Hard.™ a community-based environmental change intervention to prevent obesity in culturally diverse, early elementary school children reduced weight gain over one school year. The multi-faceted program was designed and implemented by researchers from the Friedman School of Nutrition Science and Policy at Tufts University and the Tufts University School of Medicine in close collaboration with the community. The first year results reflect efforts of children, parents, teachers, school food service providers, health care providers and policy makers, as well as city departments, before-and-after school programs, restaurants, and local media outlets to provide and promote healthy eating options and physical activity among elementary school-aged children in Somerville, Massachusetts.

Corresponding author Christina Economos, PhD, assistant professor and New Balance Chair in Childhood Nutrition at the Friedman School, and colleagues used a measure called BMI-z score (or BMI-for-age percentile)* to report a reduction in weight gain among children who participated in the Shape Up Somerville (SUS) intervention, as compared to children in two socio-demographically similar communities in Massachusetts who did not receive the intervention.

"On average, SUS reduced approximately one pound of weight gain over eight months for an eight-year-old child. This may seem small for an individual, but on a population level this reduction in weight gain, observed through a decrease in BMI z-score, would translate into large numbers of children moving out of the overweight category. Such a reduction is important given today's obesigenic environment where the shifts continue to be observed in the opposite direction," says Economos.

A key element of the intervention was the work done in collaboration with Somerville schools. Economos and her team planned and implemented a range of initiatives designed to provide and promote healthy eating options and physical activity. These included:

* Work with the school food service director to offer healthier foods, develop more healthful recipes, and promote consumption of new foods through interactive education programs in the cafeteria

* An after-school curriculum that included creative cooking, cooperative games, yoga, soccer, and field trips, including a farm visit to learn how food is grown

* An in-class curriculum with all first through third grade teachers that included daily "cool moves" sessions, weekly nutrition and physical activity lessons, and fun and healthy giveaways

* Evaluation and expansion of school wellness policies, such as those that impact school health and physical education environments, and pedestrian safety

The intervention went well beyond the Somerville schools. Parents and community members were encouraged to participate through school, after- school, and community events. There were parent forums to engage members of the four major language communities in Somerville: English, Spanish, Portuguese, and Haitian-Creole, newsletters with health tips, walking contests, traffic calming campaigns, and coupons for healthy foods. The SUS team also worked with school and community officials to establish a city employee fitness and wellness benefit. School nurses, pediatricians, and family physicians were trained to address issues of overweight and obesity among children. SUS also collaborated with 21 local restaurants to develop the SUS stamp of approval, which indicates that the restaurant offers healthy menu options.

"If this seems like a very large number of activities, it is" says Dr. Economos, "but we believe that it is the sum of these efforts that will guide children to form habits that prevent excess weight gain as they move into their teenage and adult years. Many programs offer nutrition and physical activity education, but SUS also worked with individuals and community organizations that shape a child's environment, improving the chances that the healthful changes they make will last."

Community interventions such as SUS are not without challenges, says Economos. "SUS researchers spent several years building relationships within the Somerville community before the intervention could be implemented." The researchers were only able to measure and follow BMI z-scores for approximately 60 percent (385/631) of students assigned to the intervention community mainly because children moved out of the area. Economos concludes, however, that "Creating programs like SUS for communities is essential as the US obesity rates have more than tripled in children in the last three decades. Furthermore, given the intractable nature of the condition once established, proactive strategies that begin during childhood are needed to prevent overweight."

Co-authors are Raymond R. Hyatt, Jeanne P. Goldberg, Aviva Must, Elena N. Naumova, and Miriam E. Nelson, all of Tufts University, and Jessica J. Collins, formerly the project manager on the Shape Up Somerville: Eat Smart. Play Hard.™ study, which was largely funded by the Centers for Disease Control and Prevention. Additional support was provided by Blue Cross and Blue Shield of Massachusetts, Inc. and Blue Cross and Blue Shield HMO Blue of Massachusetts, Inc., United Way of Massachusetts Bay, the United States Potato Board, Stonyfield Farm, and the Dole Food Company. The New Balance Chair in Childhood Nutrition at the Friedman School is funded by the New Balance Foundation.

*Body mass index (BMI) is the relationship between height and weight. (BMI)-for-age, expressed as a z-score or percentile, indicates the relative position of the child's BMI number among children of the same sex and age. A BMI z-score between the 85th and 95th percentile is considered at risk for overweight, while a BMI z-score at or above the 95th percentile is considered overweight. Standardized BMI z-scores and the corresponding percentiles were constructed by the Centers for Disease Control and Prevention based on historical child heights and weights.